Atlnurstudt

Hi, I'm a RN mom in GA (SAHM right now). I have an 8 year old little girl who and has ADHD & Aspergers. She takes Adderall at school around lunch time (I wrote down to give it at 11:45). It has to be taken at school. Today she came home and said she never took it. So, I know most 3rd graders could take on the responsibility to go take it on the way to lunch, etc., without the classroom teacher getting involved, but due to her disabilities, this isn't realistic for her. I'm not really sure if I should say anything to the nurse (they do have a RN on staff at the school in her own clinic everyday during school hours), teacher, neither, both. I'm also a bit more concern being that it is a controlled med (and you just never know). In the hospital this would be a big deal with incident reports filed, etc., but I don't know how this works in the school systems (and it may be different in each state; I don't know). Any advice for me? I feel like I'm hitting walls sometimes in the school system since her disabilities are more invisible, but I don't want to step on any toes the first week of school. TIA, Carrie

Oh gosh, I take NCLEX on Friday and am going to be bleeding like a stuck pig from my period... Anyone know if I need to reschedule? I am going to have to take quite a few breaks I'm afraid. Since my second baby my period is hell. What exactly are the rules for belongings in the bathroom?( b/c I always use Purell when using a public restroom, too).

I have both. I don't use the CD anymore though b/c I love the app so much. I would guess there are duplicates, though now Saunders has 4 more apps with 1000 questions each, so if you want to lessen the chance for duplicates, maybe get one of the newer question sets.

Well, I got a 68, so I guess that's good. But kinda cutting it close. Did you ask specifically about the CD test? The book test says 70 or better is a good score, but the chapter questions (the new 2010 guide has a content review with 11 sets of 25 or so practice questions) in the book are super easy, so the book test might be easier than the CD test.

What is a good score on the test on the Kaplan CD that is in the back of their NCLEX-RN review workbook? People have posted about scores on the Q trainers and Q bank but I'm not sure if the same score(s) apply for their CD (there is only one test with 180 questions). And if someone out there has done the CD test, and has done the Q-Bank or Q trainers, are the questions similar, is the format similar? I'm trying to decide if I want to pay for the Q-bank or Online Kaplan Course, or just stick with what I'm doing, which is Saunders Comp. Review book, Saunders app on the iTouch, Mosby apps on the iTouch, and the LaCharity book. Thanks!

Just wanted you to know I will be in a similar situation. I'm graduating (BSN) in December and hope to hire into the PICU. My daughter has been hospitalized in this PICU twice and this children's hospital 5 other times not in PICU. All within her first 3 years of life (she's now 4). Long story short, she had an undiagnosed heart defect and was hospitalized 3 times before diagnosis, and 4 times after for the heart repair and then related respiratory stuff. So, I don't think it's up to them to decide your motives. Would there be anything wrong with you just wanting to work in PICU because of the experience with your son? I really don't think so; you know yourself and your emotional health better than anyone else and I think having an experience with you own child only makes you a better pediatric nurse, esp. in regards to dealing with parents (I would emphasize that in your interview). You have been there as a parent and that experience is priceless in so far as caring for the family. It isn't called family centered care for nothing...and I know I haven't actually gotten out there yet...I just know that when they ask me why I want to work in peds, I'm going to be 100% honest about what developed my interest. Oh, and I started nursing school before I knew there was anything wrong with my daughter and I already knew I would be a good fit for critical care, so I will also emphasize this in my interview. I will emphasize my strengths as a nurse (love for complexity, high acuity, lines, assessment, variety in patho, excellent critical thinking skills), and how my experience as a mom on the other side of the fence will just add to the total package. Btw, I'm starting my preceptorship in this PICU this week, my preceptor asked me on the phone if I'd been to the hospital before:lol2:. I said yes, my child has been hospitalized there twice in the PICU and in the hospital 7 times. Very matter of fact like that, I only went into detail as far as to say she has a heart defect. I'll let her bring it back up if she would like to know more, I'm totally comfortable talking about it but there is still that balance of being professional but having your boss and coworkers know your background. In the end I feel like it's just part of who I am as a nurse, and quite frankly a person, I couldn't hide that if I tried to. Having a sick child changes you. Nothing like what you learn from nursing your own child...So...sorry for the ramble, I know that this may not have helped you much, but at least you know there is someone else who will be interviewing in a similar position. Good Luck and let us know how it turns out! Carrie

Thanks...maybe that's the issue with neonates and rocephin (a pp said something about it). I would think that if they're septic, or on their way to becoming septic, that their blood flow may not be optimal? Is cardiac output altered in sepsis? Or maybe it's just the tiny anatomy??? Hmmmm... Carrie

Thanks guys! I'm all set I think if I pull a central line for check-off. The others are meds, iv meds, wound care (sterile dressing change), urinary cath, trach suction and care, and ng tubes. I think I'm ok on those, a lot to remember though. We have so many things that are automatic failures so that is why it is so nerve racking! My check-off is tomorrow at 12:20pm so I'll let you know how I do!!! Thanks again, Carrie

Ahhhh....my answer (I think): http://www.icufaqs.org/CentralLines.doc So the part where the three lumens appear to join actually still consists of three lumens wrapped up all in an outer plastic, or whatever material, tube? Makin' sense now...distal, medial, and proximal, get that too now. Yea. Not that this now has anything to do with check-offs, but it was irking me. I just didn't understand how the device was actually made...it's not like we dissect them in lab, and believe me, they didn't go over the anatomy of a triple lumen. We just went over the different types of central lines. Lets all celebrate so I can stop bugging you! Carrie

Wow. Thanks so much! Now my stubborn brain is happy. I just can't take something and do it "just because". I don't think that's good practice, esp. when you graduate and are responsible for lives under a license you worked so hard for. (Trust me when I say that a lot of nursing students have no idea "why" you do something, they just know to do it). I always want to know the why, which should be the norm. So... Are the medications just going through there so fast that it normally isn't an issue even for the small time they are together in the catheter after they meet, inside the body? They don't have time to react with one another and then they hit the heart and are quickly dispersed? Because like the pp said about the rocephin and calcium, and there is apparently some problems also with dilantin, there seems to be some problems happening, albeit rare. Is this right??? I'm doing my preceptorship in the PICU so I'm sure I'll learn a lot about this stuff. Good info on the carrier line and heparin. I was wondering if it would be better to set up IVPB to primary if possible in order to avoid heparin depending on the client and situation. I think I was told by someone you'd just infuse your IVPB on one of the other lumens (at least for check-offs, though I think either would be acceptable in practice, assuming the IVPB is compatible?). Carrie Oh, and you should teach/precept...you explained that nicely.

Yes, I understand the concept, and I've got my answer, I guess, but still, in triple lumens it seems like the meds hit at the same point in the catheter on it's way to the heart, here's a picture: http://connection.lww.com/Products/taylor5e/documents/Ch46/jpg/46_010.jpg How can the medications not mix in there when they meet in the catheter once the three lumens come together as one. Am I smoking crack here??? "Think about it this way: if the pt did not have a triple, but say had two periph lines, and you give incompatible drugs in the separate lines, they would also mix in the blood stream, no?" But here they are being infused into totally different veins, not the same one. Ugh... Sorry, I like to know the nitty gritty and I'm not happy until I understand not just the answer but the why... Carrie Oh, and thanks...btw, those who don't want to help, don't have to respond

I know that the meds won't mix in the lumen of the triple lumens, but will they mix when they enter the blood stream and then react? I did some more research on the web and it seem that the point of triple lumen is to be able to administer incomp. meds in critical care and trauma and if they're administering TPN. I know the protocols will differ on amount to flush and amt and if to heparinize. These will be given to us in check offs. Unfortunately we were taught this for only a short 5 minutes or so (for me almost 2 years ago) and our lab manuel doesn't go over it at all, except to say that agencies will differ on their protocols. I'm assuming if there is a primary infusing and your med is a push and is comp. that you could just pinch the primary, swab, push med., then unpinch. If the med is uncomp. now I'm thinking that you would just swab, flush, push med, flush and hep. lock. to the other non-blood port (not distal). If it's an ivpb I'm thinking to not bother piggy backing it into the infusing fluids but to just set it up with primary tubing to the other non-blood port, flushing before and after it's done and then hep. lock according to protocol. If the ivpb med ordered is not compatible then I'd do the same thing. Does this sound right? I'm just nervous about the non-compatible meds mixing somewhere after they leave the catheters. Oh, and please do not assume I have not exhausted all of my resources. Our instructors unfortunately are not perfect (nor available 24/7) and this was just a gray area for many students!!! I have maintained a 4.0 through the program and will hopefully, if I pass this check-off , graduate summa cum laude in December. My weakness is the hands on stuff, however, and since we only have 3 total check-offs in our entire BSN program I get super nervous, (yeah I think it should be more that that too)!!! I'd rather be taking boards on Friday!!!! Thanks for your help...hopefully you'll let me know if I'm on the right track... Carrie

I have nursing school senior check-offs on Friday (last semester). If you have a triple lumen central line and a fluid of some sort is infusing and then you have an order for a med, either IV push or IVPB, where do you hook this up and do you flush/when/etc. I'm mainly confused about the incompatibility issue. So here are the senarios... Primary infusing with: IVPB ordered compatible. IVPB ordered incompatible. IV push ordered compatible. IV Push ordered incompatible. If you can help me you will seriously save my life (or ability to graduate in December anyway). Thanks! Carrie

Thanks for the thoughts! We can't wear printed jackets either, we can't even wear a shirt under our scrubs unless we wear same color jacket over the ensemble. It's quite strict, a bit extreme in my opinion. But, I'm a newbie so I'm trying to remain open minded. My little girl has been hospitalized 7 times in the last 2.5 years and I couldn't even begin to count the ER visits, and even myself as the parent greatly appreciated the cheery colorful environment, due in part to spongebob, mickey, etc. scrubs, in a stressful and scary time. Depends how you look at it I guess, my little girl was life flighted one time in critical condition so I was in that mind set that the pp mentioned and to tell you the truth, my mind was not on scrub prints, but everyone is different. Can't make everyone happy. I see the professionalism looking point. The differentiation or security points I don't necessarily agree with because of the name badge thing and other options available for these puposes. Plus any individual who really wants to do harm is not going to be deterred by a dress code. Anyone can buy navy and light blue scrubs. I've always relied on the name badges, personally, and not had any problems. I can see people getting grumpy about the policy, I myself am going to need convincing before I would consider working at this hospital versus the peds hospital very close by, not to be narrow minded or anything, it's just I love kids, and part of my draw to peds is the colorfulness and the effort to try and be as non-hospitalike as possible. I would be very interested to hear if there are indeed any major pediatric centers that have adopted a strict uniform policy...anyway, alas the debate draws on. Carrie

I would define kid friendly as being scrubs that are colorful, printed, or at least have staff not all wearing the same thing, even if that means sticking to solids. Even in nursing school we aren't allowed to wear our all white uniforms to peds clinical, they're afraid we'll scare the kids. If the department is well decorated and kid friendly, I can see the uniformity thing working if it has too, but what's the point is more my question. Why make everyone wear the same thing. You seldom see docs. wearing their white coats in peds for similar concerns. I wouldn't go near my grandfather growing up (a MD) until he took his white coat off. Kids have a way of remembering bad experiences and associating them with things like a person wearing a white coat or, in this instance, dressed from head to toe in royal blue. I'm speaking of a strict "scrubs in this color only" policy, not wearing scrubs...